Is primary dysmenorrhea a precursor of future endometriosis development?

Abstract

Primary dysmenorrhea (PD) is the most common gynecologic disorder during adolescence and it is characterized by crampy lower abdominal pain that occurs during menstruation. Secondary dysmenorrhea, in contrast, has the same clinical features but occurs in women with a disease that could account for their symptoms (endometriosis, adenomyosis, uterine fibroids, pelvic inflammatory disease). Endometriosis is the most common cause of secondary dysmenorrhea and it should be considered in patients with persistent and clinically significant dysmenorrhea despite treatment. It is often diagnosed after a long delay, increasing the likelihood of pain chronicity and fertility problems at a later age. Women who suffer from dysmenorrhea in adolescence have higher risk of endometriosis in future. The open question is if endometriosis was already present at the onset of dysmenorrhea but undiagnosed or if PD favors subsequent development of endometriosis-associated pain. Since PD is associated with higher risk for developing chronic pain state and shares some of the same pain pathways of endometriosis (prostaglandins overproduction, inflammation, peripheral sensitization, central sensitization and abnormal stress responses), a correlation between PD and endometriosis is suggested. To know whether it is a risk factor for the development of endometriosis-associated pain may provide an opportunity for early intervention and prevention. The present review aims to investigate the clinical and pathogenetic features of PD and endometriosis in order to identify a possible association between the two conditions.

摘要

原发性痛经 (PD) 是青春期最常见的妇科疾病, 其特征是月经期间发生痉挛性的下腹疼痛。相比之下, 继发性痛经具有相同的临床特征, 但是发生在患有可以解释其症状的疾病(子宫内膜异位症、子宫腺肌病、子宫肌瘤、盆腔炎)的妇女中。子宫内膜异位症是继发性痛经最常见的原因, 经治疗后持续并且有临床显著痛经的患者应考虑子宫内膜异位症。它通常在长时间的延迟后才被诊断出来, 这增加了以后患慢性疼痛和生育问题的可能性。青春期患有痛经的女性将来患有子宫内膜异位症的风险更高。一个悬而未决的问题是, 子宫内膜异位症是否在痛经开始时就已经存在, 但尚未确诊, 或者PD是否有利于子宫内膜异位症相关疼痛的后续发展。由于PD与子宫内膜异位症慢性疼痛状态的高风险相关, 并且与子宫内膜异位症有一些相同的疼痛途径(前列腺素分泌过多、炎症、外周敏化、中枢敏化和异常应激反应), 因此PD与子宫内膜异位症之间存在相关性。了解它是否是子宫内膜异位症相关疼痛发展的危险因素可能为早期干预和预防提供机会。

本综述旨在研究PD和子宫内膜异位症的临床和病理特征, 以确定这两种疾病之间的可能联系。

Keywords:

• Primary dysmenorrhea
• endometriosis
• chronic pelvic pain
• prostaglandins
• peripheral and central sensitization

Acknowledgements

The authors have no acknowledgements to make.

Disclosure statement

No potential conflict of interest was reported by the author(s).